Evidence favouring the gastro-oral route in the transmission of Helicobacter pylori infection in children

Objective Several studies support the view that Helicobacter pylori is acqu ired in early life and within families. However, the exact route of transmi ssion remains unknown, Given that H. pylori colonizes only the human gastri c mucosa, the hypothesis that history of vomiting in siblings may be a rele vant risk factor was tested in a paediatric setting. Methods One hundred urban children (age range 0.8-16.6 years, median 9), 44 % with evidence of active H. pylori infection, were recruited. A structured questionnaire dealing with socio-economic issues was completed. Vomiting s iblings and siblings of vomiting index children were screened for H. pylori by means of C-13-urea breath test. Serum samples from index children were assayed for immunoglobulin G to hepatitis A (HAV) and Epstein-Barr virus (E BV) in order to check for faecal-oral and oral-oral exposure, respectively. Results Vomiting siblings of H. pylori-infected index children and siblings of H. pylori-infected vomiting index children had a high rate of active H. pylori infection (60 and 67%, respectively). History of vomiting in siblin gs was positively associated with active H. pylori infection in the index c hildren (multivariate odds ratio 2.4, 95% confidence interval 1.3-4.3). Ser opositivity for HAV and EBV was found in 1 and 68 index children, respectiv ely. The agreement between active H. pylori infection and EBV seropositivit y was not significant (kappa = 0.26). Conclusions History of vomiting in siblings is an independent risk factor f or H. pylori. Nowadays, transmission of H. pylori in urban children may inv olve the gastro-oral route more than the faecal-oral or oral-oral pathways. (C) 2000 Lippincott Williams & Wilkins.